Patients with Heart-Related Problems - Essay Example

Induced Hypothermia Introduction Patients continue to be affected by heart related problems. In particular, cardiac arrest has been a major challenge to most individuals. Cardiac arrest refers to stopped mechanical activity of the heart thus leading to stopped blood flow. Medical interventions have been applied in pre-hospital care to help cardiac arrest patients achieve normal operation of their circulatory system. This paper looks at the various researches that have been conducted in assessing the importance of therapeutic hypothermia in providing care to cardiac arrest patients. Study, Authors, Date Type of study Sample Design and method Results conclusion Therapeutic hypothermia after cardiac arrest implementation in UK intensive care units (Binks, Murphy, Prout, Bhayani, Griffiths, Mitchell, Padkin, and Nolan, 2010) Descriptive, non-experimental UK ICUs entries in the 2008 directory of critical care The study was conducted using questionnaires. For the 243 ICUs, 208 (85.6%): had used therapeutic hypothermia 206 (99%) used it in hospital VF/ventricular tachycardia (VT) arrest. 126 (61%) :after pulses electrical activity 132 (64%) usually or sometimes use it following in-hospital cardiac arrest Uptake by UK ICUs of therapeutic hypothermia following cardiac arrest increased to 85.5% in 2009 Hypothermia and rapid rewarming is associated with worse outcome following traumatic brain surgery (Thompson, Catherine, and Mitchell, 2010) Descriptive, non-experimental patients admitted at level 1 trauma centre following severe traumatic brain injury Secondary data analysis was conducted on patients admitted at level 1 trauma cetre following severe TBI from January 200 to January 2002 Hypothermia was common in this sample, present in 40% of subjects. The mean temperature on arrival to the ED of normothermic subjects (n=8) was 36.30C The mean temperature of hypothermic subjects (n=59) was 34.20C. 58 of 59 subjects experienced a mild degree of hypothermia on admission. The presence of hypothermia on admission was correlated with worse outcomes including ICU LOS, functional outcomes (GCS and Glascow Outcome Scored-Extended), and death in their sample of brain injured patients Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock sysndrome (Skulec, Kovarnic, Dostalova, Kolar, and Linhart, 2007) Retrospective analysis Cardiac arrest survivors treated by MH Retrospective analysis of all consecutive cardiac arrest survivors treated by MH in CCU from Nov 2002 to august 2006. In Group A, 28 met the criteria of cardiogenic shock. In Group B, 28 were relatively stable. In-hospital mortality (57.1%) group A and (21.4%) group B. 28 pteints Induction of MH should be considered in cardiac arrest survivors with CSS after ROSC. Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia (Torgersen, Strand, Bjelland, Klepstad, Soreide, Larsen and Flaatten, 2010) Descriptive, non-experimental 26 patients (13-28) months after suffering from cardiac arrest Groping of patients was done according to the Cerebral Performance Category Scale (CPC) and Mini-Mental State Examination (MMSE). Testing of 25 pateints according to Motor Screening test, Delayed Matching to Sampole, Stockings of Cambridge and Paired Associate Learning from CANTAB 52 patients had cognitive dysfunction. Cognitive dysfunction cannot be related to age and time Reduced performance did not affect HRQOL 50% percent of the patients experienced cognitive dysfunction Therapeutic hypothermia for out-of-hospital cardiac arrest (Lee and Asare, 2010) Descriptive, non-experimental European study: 275 pateints in nine european hospitals. European Study: 77 comatose patients after successful resuscitation with an initial cardiac rhythm of VF European study: A large, multi centre, randomized controlled study was conducted by the hypothermia after cardiac arrest study group. Australian study: this prospective study randomly assigned patients to either the hypothermia (n=43) or normothermia group (n=34) according to the day of the month Hypothermia results in favorable neurologic TH can be used to help patients recover from cardiac arrest Therapeutic Hypothermia after Cardiac Arrest Binks et al (2010) carried out a study to determine how many intensive care units in the United Kingdom were using Hypothermia as part of their post-cardiac arrest management. The study was conducted in all UK ICUs that were present in the 2008 UK directory of critical care. However, the information important to this study was obtained 243 intensive care units (98.4%). After carrying out the study, Binks et al (2010), found out that out of 243 investigated intensive care units, about 85.6% (208) had used therapeutic hypothermia for patients after suffering from cardiac arrest. Further, out of the ICUs using therapeutic hypothermia; 206 (99%) usually or sometimes considered the use of TH in patients who had an out of hospital VF/ Ventricular tachycardia (VT) arrest. In addition, 126 (61%) usually or sometimes used TH after patients had undergone pulse less electrical activity (PEA). Finally, 132 (64%) usually or sometimes used TH following in-hospital cardiac arrest. The study showed that the use of TH in the United Kingdom’s intensive care units had increased after the introduction of the international Liaison Committee on Resuscitation (ILCOR) recommendations. Several intensive care units across UK have decided to use therapeutic hypothermia to treat patients suffer from cardiac arrest. Clinical practice based on previous research (evidence based practice) has since shaped the way patients are being cared for. Clinicians had decided to use the available research on therapeutic hypothermia to treat cardiac arrest patients. Hypothermia and Rapid Re-Warming According to Thompson, Catherine and Mitchell (2010), the presence of hypothermia on admission was correlated with worse outcomes including ICU length of stay (LOS), functional outcomes (GCS and Glascow Outcome Scored-Extended), and death in their sample of brain injured patients. Their main aim was to determine the prevalence and level of hypothermia in patients on emergency admission and the effect of hypothermia and rate of re-warming on patient outcomes. The study was conducted on patients recovering at level 1 trauma centre. The patients were assessed after undergoing traumatic brain injury. Further, the researchers grouped the patients on the basis of temperature recorded at the time of admission according to hypothermia status. Patients were also grouped according to rate of re-warming (rapid or slow). In addition, the researchers used secondary data to come up with the conclusions (Thompson, Catherine and Mitchell, 2010). The researchers concluded that hypothermic patients were at a greater risk to have lower post resuscitation and a higher initial injury severity score (according to 0 Glasgow Coma Scale scores). In addition, they also asserted that hypothermia on admission was associated with longer intensive care unit stays. Hypothermia helped doctors to care for cardiac patients longer that when not used. Consequently, they concluded that patients with traumatic brain injury who are rapidly re-warmed had their conditions deteriorating (Thompson, Catherine and Mitchell, 2010). Induction of mild hypothermia in cardiac arrest patients presenting with cardiogenic shock syndrome Skulec et al (2007) concluded that induction of the mild hypothermia (MH) should be considered in cardiac arrest patients with Cardiac Shock Syndrome (CSS) after the return of spontaneous circulation (ROSC). The researchers reached this conclusion by performing retrospective analysis of all consecutive cardiac arrest survivors. These patients were induced by mild hypothermia while recovering from their Coronary Care unit (CCU). The study was conducted from November 2002 to august 2006. The subjects were classified into two groups based on their ability to meet the guidelines for cardiogenic shock. The researchers found out that out of 56 consecutive patients; only 28 patients met the required criteria of cardiogenic shock before MH initiation (Group A). In Group b 28 patients were relatively stable before MH initiation. Further, Group A registered a score of 57.1 % in in-hospital mortality while 21.4% was registers in group B patients. Consequently, the researchers asserted that favorable neurological outcome anytime during hospitalization was registered in 67.9% of group A patients and in 82.1% in group B patients (Skulec et al, 2007). Cognitive Dysfunction and Health Related Quality Of Life According to Torgersen et al (2010), mild cognitive deficits have been registered in patients from out-of-hospital cardiac arrest. In addition, the researchers found out that a higher functional status in patients being treated with therapeutic hypothermia. However, higher functional status cannot affect health related quality of life (HRQOL). The study was conducted using 26 patients who had stayed for up to 13-28 months after suffering from cardiac arrest. The results were recorded according to the Cerebral Performance Category scale (CPC). In addition, Mini-Mental State Examination was also used to determine patient scores. In particular, the researchers used 25 patients who had to undergo cognitive function testing. Cognitive function testing is usually done according to the Cambridge Neuropsychological Test Automated battery (CANTAB). The patients were subjected to motor screening test, delayed matching, Stockings of Cambridge and paired Associate Learning guidelines from CANTAB (Torgersen et al, 2010). The researches found out that 52% percent of the total patients had a cognitive dysfunction. In addition, the researchers found out that motor function and delayed memory had no difference when compared with reference population. However, they found out that significant differences arose in executive function as well as episodic memory. Further, there was no linkage among cognitive function and age, time after cardiac arrest (Torgersen et al, 2010). Therapeutic Hypothermia for Out-Of-Hospital Cardiac Arrest Therapeutic hypothermia can be used in improving patient health conditions after cardiac arrest. This conclusion was reached after studies conducted in Europe and in Australia. In the European study, a controlled study was conducted on 275 patients in nine European hospitals. In this research, the researchers were expected to find the association between mild hypothermia and standard normothermia after resuscitation who suffered from cardiac arrest. In the Australian study, the researchers used 77 comatose patients. The patients were examined after successful resuscitation using an initial cardiac rhythm of VF. The Australian research also ensured that patients are randomly assigned to hypothermia and normothermia (Lee and Asare, 2010). From the European and Australian studies, researchers concluded that despite progress registered in pre-hospital care, the survival rate from TH stands at 6-12%. Consequently patients who have suffered from cardiac arrest register devastating consequences such as mild memory impairment and permanent brain damage. Further, they concluded that timely induction of hypothermia produces an optimal effect (Lee and Asare, 2010). The researches also conclude that optimal methods of cooling have not been determined. This is after several methods have been adopted to induce hypothermia. There are problems associated with cooling, they include; coagulopathy, increased chances of infection, hemodynamic changes, heart complications and hyperglycemia (Lee and Asare, 2010). Conclusion Therapeutic hyperthermia leads to increased heart rate thereby leading to the functioning of circulatory system in cardiac arrest patients. Hypothermia can increase heart beat rate thus eliminating the chances of succumbing to cardiac arrest. In addition, therapeutic hypothermia leads to reduced intracranial pressure. Intracranial pressure is normally experienced in patients undergoing traumatic rain surgery. Survival of patients suffering from cardiac arrest and traumatic brain injury can be enhanced through the use of therapeutic hypothermia. References Binks, A., Murphy, E., Prout, E., Bhayani, S., Griffiths, T., Mitchell, A., Padkin, A and Nolan, J (2010), Therapeutic hypothermia after cardiac arrest implementation in UK intensive care units, Journal of the Association of Anesthetists of Great Britain and Ireland, Anaesthesis, 2010, (65): pp260-265. Lee, R and Asare, K (2010), Therapeutic hypothermia for out-of-hospital cardiac arrest, American Journal of health-system pharm: vol 67 Aug 1, 2010. Skulec, R.., Kovarnik., Dostalova, G., Kolar, J., and Linhart, A (2008), Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome, Acta Anaesthesiol Scand 2008(52): 188-194. Thompson, H., Catherine, J and Mitchell, P (2010), Hypothermia and rapid re-warming is associated with worse outcome following traumatic brain surgery, Journal of Trauma Nursing; volume 17, number 4. Washington DC: university of Washington. Torgersen, J., Strand, K., Bjelland, W., Klepstad, P., Kvale, R., Soriede, T., Larse, and Flaatten, H (2010), Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia, Acta Anaesthesiol Scand 2010(54): 721-728. Read More